Bone and Soft Tissue Tumours Flashcards
what is a sarcoma
malignant tumour of connective tissue
most common spread of a sarcoma
lungs
what is a malignant tumour of bone called
osteosarcoma
malignant tumour of vascular tissue
angiosarcoma
malignant tumour of fat
liposarcoma
what is Ewing’s sarcoma a tumour of
bone marrow
what is chondrosarcoma a tumour of
malingnat cartilage
what a giant cell tumour
tumour, benign or malignant of uncertain origin
red flags symptoms of a soft tissue mass
deep >5cm rapid growth hard, craggy and non-tender fxed deep ache that is worse at night
what is the commonest soft tissue tumour
lipoma - benign fat
commonest primary malignant bone tumour in younger patients
osteosarcoma
age peak of osteosarcoma
15-19 years
presentation of osteosarcoma
deep boring pain not related to activity and worse and night not responsive to analgesia limp or reduced movement swelling pathological fracture joint effusion deformity neurovascular deficit
where is osteosarcoma commonest
knee (75%) then proximal humerus
what is the best imaging modality for osteosarcoma
MRI - will show extent within and outwith bone and any skip metastases
what investigations would you order when someone present with bone pain
x-ray
alkaline phosphatase
lactate dehydrogenase
serum Ca2+
investigation to look for bony metastases to lungs
CT or x-ray
features of haemangioma on x-ray
phleboliths in blood vessles (calcifications)
features of a malignant bone tumour on x-ray
undefined margins
cortical destruction
reactive bone growth - sunburst, codman’s triangle or onion skin
necessary test to do before a biopsy
bloods x-ray of limb and chest MRI bone scane CT chest, abdo and pelvis
name 3 primary malignant bone tumour
osteosarcoma, Ewing’s sarcoma and chondrosarcoma
treatment for osteosarcoma
surgery AND chemotherapy
what does Ewing’s sarcoma arise from
mesenchymal stem cells
what type of reactive bone formation is seen on x-ray of Ewing’s sarcoma
onion skin
general treatment option in bone tumours
Surgery
Chemotherapy
Radiotherapy
MDT
5 common primaries that metastasise to bone
breast lung prostate kidney thyroid
5 common site for bone metastases to appear (in order)
vertebrae > proximal femur > pelvic > ribs > sternum > skull
what scoring system is used to assess whether or not prophylactic internal fixation is necessary
Mirel’s scoring system
range of scores in Mirel’s and what they mean
min = 4
max = 12
recommended prophylaxis = 8
features used to determine a Mirel score
site, lesion type, size and degree of pain
other factors used to decide on prophylactic fixation than mirel’s score
if the lesion is >2.5cm, increasing pain or >50% cortical destruction
treatment of a pathological fracture
splint and/or traction while you investigate it
fixation
unlikely to fully heal
what do you do with renal metastases from bone
radically excise
what is the commonest primary of bone metastases
breast
true/false - the prognosis of breast cancer is better if the metastases are in soft tissue than in bone
false - better prognosis when to bone than soft tissue
in bone disease, alkaline phosphatase is raised/lowered
raised
what part of the liver does alkaline phosphatase come from
bile ducts
sources of alkaline phosphatase
bile ducts, placenta, bone and intestines
